CVS Health Corp (CVS) 2024 Q3 法說會逐字稿

Good morning. And thank you all for attending the CBS Health third quarter, 2024 earnings call and webcast. My name is Brika and I will be your moderator for today. All lines will be muted during the presentation portion of the call with an opportunity for questions and answers. At the end, I would now like to pass the conference over to your host, Larry mcgrath at CV S Health. Thank you. You may proceed Larry.

早安.感謝大家參加 CBS Health 2024 年第三季財報電話會議和網路廣播。我的名字是 Brika，我將擔任今天的主持人。在通話的演示部分，所有線路將被靜音，並有機會進行提問和回答。最後，我想將會議交給主持人 CV S Health 的 Larry mcgrath。謝謝。你可以繼續拉里。

Good morning and welcome to the CV S Health third quarter, 2024 earnings call and webcast. I'm Larry mcgrath. Chief Strategy Officer. I'm joined this morning by David Joiner, President and Chief Executive Officer and Tom Cowie, Chief Financial Officer.

早上好，歡迎來到 CV S Health 2024 年第三季財報電話會議和網路廣播。我是拉里·麥克格拉斯。首席策略長。今天上午，總裁兼執行長 David Joiner 和財務長 Tom Cowie 也加入了我的行列。

Following our prepared remarks. We'll host a question and answer session that will include additional members of the leadership team.

以下是我們準備好的發言。我們將舉辦問答會議，其中包括領導團隊的其他成員。

Our press release and slide presentation have been posted to our website along with our form 10-Q filed this morning with the SEC.

我們的新聞稿和幻燈片簡報以及今天早上向 SEC 提交的 10-Q 表格已發佈到我們的網站上。

Today's call is also being broadcast on our website where it will be archived for one year during this call. We'll make certain forward-looking statements.

今天的電話會議也在我們的網站上播出，該電話會議期間的內容將存檔一年。我們將做出某些前瞻性陳述。

Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from currently projected results.

我們的前瞻性陳述面臨重大風險和不確定性，可能導致實際結果與目前預測結果有重大差異。

We strongly encourage you to review the reports we file with the SEC regarding these risks and uncertainties, in particular, those that are described in the cautionary statement concerning forward-looking statements and risk factors. In our most recent annual report filed on form 10-K, our quarterly report on form 10-Q filed this morning and our recent filings on form eight K including this morning's earnings press release.

我們強烈建議您查看我們向 SEC 提交的有關這些風險和不確定性的報告，特別是有關前瞻性陳述和風險因素的警告聲明中所述的報告。在我們以 10-K 表格提交的最新年度報告中，我們今天早上以 10-Q 表格提交的季度報告以及我們最近以 8 K 表格提交的報告，包括今天早上的收益新聞稿。

During this call, we'll use non-GAAP measures when talking about the company's financial performance and financial condition and you can find a reconciliation of these non cop measures in this morning's press release and in the reconciliation document posted to the investor relations portion of our website.

在本次電話會議中，我們將在討論公司的財務業績和財務狀況時使用非公認會計準則衡量標準，您可以在今天上午的新聞稿以及發佈到投資者關係部分的對帳文件中找到這些非公認會計準則衡量標準的對帳。

With that, I'd like to turn the call over to David. David.

說到這裡，我想把電話轉給大衛。大衛.

Thank you, Larry and Good morning. Everyone before I begin, I would like to thank Karen Lynch for her years of leadership, dedication and strategic vision. Karen is a friend to me and many others across the CBS Health Organization and we wish her all the best.

謝謝拉里，早安。在開始之前，我要感謝凱倫·林奇（Karen Lynch）多年來的領導能力、奉獻精神和戰略遠見。凱倫是我和哥倫比亞廣播公司衛生組織其他許多人的朋友，我們祝福她一切順利。

I am incredibly honored to leave CVS Health during this critical time.

我非常榮幸能夠在這個關鍵時刻離開 CVS Health。

My entire career is deeply connected with this enterprise when I returned to CBS Health in 2023. It was because of my strong belief in our purpose and strategy. Today. CBS Health serves 185 million people across the US and we are uniquely positioned to help them navigate their health care journey.

當我在2023年回到CBS Health時，我的整個職業生涯都與這家企業深深聯繫在一起。今天。 CBS Health 為全美 1.85 億人提供服務，我們擁有獨特的優勢來幫助他們順利完成醫療保健之旅。

In the past few weeks since I took on this role, I have seen firsthand the dedication, pride and commitment of our employees to CBS health and our vision to deliver lower cost, better experiences and better health outcomes for our members, clients and patients.

自從我擔任這項職務以來的過去幾週，我親眼目睹了我們的員工對CBS Health 的奉獻、自豪和承諾，以及我們為會員、客戶和患者提供更低的成本、更好的體驗和更好的健康結果的願景。

I began my career at Aetna and have spent the last 37 years managing health care services teams with a focus on driving innovation, strong execution and consistent financial performance.

我的職業生涯始於 Aetna，在過去 37 年裡一直管理醫療保健服務團隊，重點是推動創新、強大的執行力和穩定的財務表現。

My career has been defined by navigating through change and evolving markets.

我的職業生涯是透過應對變化和不斷發展的市場來定義的。

As the leader of carear, I engage with health plans, employers, pharmacies and the broader health care delivery system in our country.

作為護理的領導者，我與我國的健康計畫、雇主、藥局和更廣泛的醫療保健提供系統接觸。

These experiences gave me a diverse set of perspectives on the challenges and opportunities inherent to our system.

這些經驗讓我對我們系統固有的挑戰和機會有了不同的看法。

I've mobilized teams who have helped reshape the pharmacy benefit landscape by lowering cost, increasing transparency and driving greater accessibility.

我動員了一些團隊，透過降低成本、提高透明度和提高可及性，幫助重塑了藥品福利格局。

Many of those innovations have been made possible by integrating the assets across this enterprise at CBS Health. Each of our businesses is formidable in its own right.

其中許多創新都是透過整合 CBS Health 整個企業的資產而實現的。我們的每項業務本身都非常強大。

We have the leading PB M, the best run pharmacy in this country, the storied franchise through Aetna and industry leading health care delivery assets.

我們擁有領先的 PB M、全國運營最好的藥房、Aetna 傳奇的特許經營權以及行業領先的醫療保健服務資產。

Our collection of businesses and omni channel capabilities allow us to lead the industry forward with innovative and market moving solutions.

我們的業務集合和全通路能力使我們能夠透過創新和市場驅動的解決方案引領產業前進。

We were pioneers in advancing the biosimilar adoption by establishing a co manufacturing capacity through court office, making the necessary formulary changes with caremark and executing through our CBS specialty operations.

我們是推進生物相似藥採用的先驅，透過法院辦公室建立聯合生產能力，透過 Caremark 進行必要的處方變更，並透過我們的 CBS 專業業務執行。

Through our leadership and innovation. We were able to drive down commercial specialty trend for clients that use our integrated biosimilar approach to 1.3%. The lowest level in recent history, we continue to expand our product offering and drive innovation for Aetnas self insured customers.

透過我們的領導和創新。我們能夠將使用我們的綜合生物相似藥方法的客戶的商業專業趨勢降低至 1.3%。這是近年來歷史上的最低水平，我們將繼續擴大產品範圍並為 Aetnas 自保客戶推動創新。

Last month, we introduced simple pay, a differentiated offering for our commercial customers that provides greater price certainty before a visit or treatment instead of bills and benefit details. Members receive just one simple monthly statement that summarizes all of their medical and pharmacy claims.

上個月，我們推出了簡單支付，這是一種為商業客戶提供的差異化服務，可在就診或治療之前提供更大的價格確定性，而不是賬單和福利詳細信息。會員只會收到一份簡單的月度報表，其中總結了他們所有的醫療和藥品索賠。

This offering provides a simpler end to end member experience and access to affordable quality, innovative health care for members and plan sponsors.

該產品為會員和計劃發起人提供了更簡單的端到端會員體驗，並提供價格實惠的優質創新醫療保健服務。

In addition, this product has been shown to drive a 60% increase in the use of top quality providers and a 12% total cost of care savings for employers and members.

此外，該產品已被證明可使頂級服務提供者的使用量增加 60%，並為雇主和會員節省 12% 的總護理成本。

Last month BM SS released its 2025 star ratings.

上個月 BM SS 發布了 2025 年星級評級。

CBS Health integrated teams helped Aetna deliver an exceptional result. We built upon our strong momentum from last year with 88% of our Medicare advantage. Members enforced our plans or higher and more than two out of every three Aetna Ma members and a plan rated 4.5 stars.

CBS Health 綜合團隊幫助 Aetna 取得了卓越的成果。我們以去年 88% 的醫療保險優勢為基礎，繼續保持強勁勢頭。會員執行了我們的計劃或更高級別的計劃，每三名 Aetna Ma 會員中就有超過兩人執行了我們的計劃，計劃評級為 4.5 星。

Our commitment to outstanding service resulted in our highest ever member experience score since C MS launched the quality Bonus Star program in 2012.

自 C MS 於 2012 年推出優質獎勵之星計畫以來，我們對卓越服務的承諾為我們帶來了有史以來最高的會員體驗評分。

This was an impressive result, particularly as C MS continues to raise the bar on what it takes to achieve a four star rating.

這是一個令人印象深刻的結果，特別是 C MS 繼續提高獲得四星級評級所需的標準。

Our success in this crucial area was achieved by enhancing our cross enterprise processes and driving focused and deliberate execution. Strengthening our position for the future, this framework and approach are critical elements. As I look to lead this organization through the opportunities and challenges ahead, it will also require the right leadership team. Today, we announced two leadership appointments that will help us drive better performance across the enterprise. And at Aetna specifically, first, Cprim Shaw, who has been running our pharmacy and consumer wellness business is elevated to group President and will now also be responsible for the health services segment.

我們在這一關鍵領域的成功是透過增強跨企業流程並推動專注和深思熟慮的執行而取得的。這個框架和方法是加強我們未來地位的關鍵要素。當我希望領導這個組織應對未來的機會和挑戰時，它還需要合適的領導團隊。今天，我們宣布了兩項領導層任命，這將幫助我們提高整個企業的績效。具體來說，在 Aetna，首先，一直負責我們的藥房和消費者健康業務的 Cprim Shaw 被提升為集團總裁，現在還將負責健康服務部門。

Second, we appointed Steve Nelson as President of Aetna.

其次，我們任命 Steve Nelson 為 Aetna 總裁。

Steve is an industry veteran who has successfully led diverse managed care companies and driven innovation and growth throughout his career, Steve was a former CEO of unitedhealthcare and held several leadership roles with a proven track record of delivering growth, profitability, improved employee engagement and customer satisfaction.

史蒂夫是一位行業資深人士，在他的職業生涯中成功領導了多元化的管理式醫療公司並推動創新和成長，史蒂夫曾擔任UnitedHealthcare 的前首席執行官，並擔任過多個領導職務，在實現成長、獲利、提高員工敬業度和客戶方面擁有良好的記錄滿意度。

I am confident both prem and Steve will help us advance our strategy and enable us to realize opportunities across our businesses.

我相信 Prem 和 Steve 將幫助我們推進我們的策略，並使我們能夠在整個業務中實現機會。

Shifting now to the results. In the third quarter, we delivered adjusted earnings per share of a dollar nine. The total revenues for the company of more than $95 billion CBS Health is made up of three attractive operating segments which are all critical to the health care system.

現在轉向結果。第三季度，我們實現調整後每股收益 9 美元。 CBS Health 公司的總收入超過 950 億美元，由三個有吸引力的營運部門組成，這些部門對醫療保健系統都至關重要。

Two of those segments continue to perform consistent with our expectations.

其中兩個部門的表現持續符合我們的預期。

Our health services segment had another strong quarter while delivering on our commitments to lower drug costs to our clients and members, our pharmacy and consumer wellness business continues to be the best run national Pharmacy in the country.

我們的健康服務部門又一個強勁的季度表現，同時兌現了為客戶和會員降低藥品成本的承諾，我們的藥房和消費者健康業務仍然是全國運營最好的國家藥房。

Increasing its share of scripts filled and delivering important community health access across the nation results in our health care benefits. Business remain challenged as a result of continued elevated levels of utilization.

增加其已填寫的腳本的份額並在全國範圍內提供重要的社區醫療服務將為我們帶來醫療保健福利。由於利用率持續升高，業務仍面臨挑戰。

While we are clearly underperforming at HCB today, this business has incredible earnings potential and is an essential element to our strategy.

雖然我們今天 HCB 的表現顯然不佳，但這項業務具有令人難以置信的獲利潛力，並且是我們策略的重要組成部分。

We expect the elevated levels utilization will continue to pressure our 2024 performance. And as a result, we are not providing a formal outlook today.

我們預計利用率的提高將繼續給我們 2024 年的業績帶來壓力。因此，我們今天不提供正式的展望。

Although Tom will provide some comments on what we may expect directionally, I appreciate and understand your desire for us to provide guidance at this stage. Establishing credibility and earning your trust is one of my top priorities. As the new leader of CBS health. I recognize that in order to achieve that any guidance we provide should be achievable with clear opportunities for our performance.

儘管湯姆會就我們可能的方向性期望提供一些評論，但我感謝並理解您希望我們在現階段提供指導的願望。建立信譽並贏得您的信任是我的首要任務之一。作為CBS健康的新領導者。我認識到，為了實現這一目標，我們提供的任何指導都應該能夠透過明確的績效機會來實現。

This must be a core principle.

這必須是一個核心原則。

And in order to deliver on that commitment to you, I want to spend more time understanding the complexities and challenges facing our Aetna business and we'll provide an update when appropriate.

為了兌現對您的承諾，我想花更多時間了解我們 Aetna 業務面臨的複雜性和挑戰，我們將在適當的時候提供最新資訊。

There are clearly both macro and company specific factors driving the challenges within our Aetna business.

顯然，宏觀因素和公司特定因素共同推動了我們的 Aetna 業務面臨的挑戰。

The entire industry has seen pressure including elevated utilization coming out of the COVID 19 pandemic and higher acuity as a result of the Medicaid redeterminations. However, I recognize that we have been more acutely impacted than others in the industry as a result of our disappointing star ratings for 2024 we began the year with the known and temporary reimbursement challenge.

整個行業都面臨壓力，包括 COVID 19 大流行帶來的利用率提高以及醫療補助重新確定帶來的更高的敏銳度。然而，我意識到，由於我們 2024 年的星級評級令人失望，我們比業內其他公司受到的影響更嚴重，我們在年初面臨著已知的臨時報銷挑戰。

When we priced our Medicare advantage business for 2024 we clearly underestimated the medical cost in this rising trend environment. We offered rich benefits which exacerbated our utilization pressures and grew membership rapidly, our individual exchange business. Another area where we had a large increase in membership has seen pockets of higher utilization and several disappointing risk adjustment updates. These miscalculations during the 2023 bid processes have significantly burdened Aetna's current results. This performance is unacceptable. However, I am confident in the long term prospects of Aetna, we will make the hard choices and take the necessary actions to drive a multi year earnings recovery at Aetna.

當我們為 2024 年的醫療保險優勢業務定價時，我們顯然低估了這種上升趨勢環境下的醫療成本。我們提供的豐富福利，加劇了我們的使用壓力，會員數量迅速增長，我們的個人兌換業務。我們會員數量大幅增加的另一個領域是利用率較高，但風險調整更新令人失望。 2023 年投標過程中的這些誤算給 Aetna 目前的業績帶來了嚴重的負擔。這種表現是不可接受的。然而，我對安泰的長期前景充滿信心，我們將做出艱難的選擇並採取必要的行動來推動安泰的多年盈利復甦。

Our benefit design and price changes and Medicare advantage and the individual exchange are down payments on this enduring commitment.

我們的福利設計和價格變化以及醫療保險優勢和個人交換是這項持久承諾的預付款。

We are making marked progress to realign the Aetna Organization and enhance management processes. We have taken meaningful steps to ensure the stability of the Aetna Business and strengthen the leadership team.

我們在重組 Aetna 組織和加強管理流程方面取得了顯著進展。我們已採取有意義的措施來確保 Aetna 業務的穩定性並加強領導團隊。

In addition to the appointment of Steve Nelson, we also recently added Andreana Santangelo, a seasoned managed care CFO to the Aetna Organization who has also been working closely with me, Tom and our Chief Operating Officer Katrina Grez to help drive operational enhancements, improve forecasting and greater accountability.

除了任命Steve Nelson 之外，我們最近還任命了Andreana Santangelo，她是Aetna 組織的一位經驗豐富的管理式醫療首席財務官，她也一直與我、Tom 和我們的首席營運官Katrina Grez 密切合作，幫助推動營運改善、改進預測和更大的責任。

Our risk management processes have been restructured to pull underwriting and pricing authority out of the business units and into the financial chain. This realignment will help improve transparency and accountability as we execute our marginal recovery and drive profitable growth.

我們對風險管理流程進行了重組，將核保和定價權從業務部門轉移到金融鏈。當我們執行邊際復甦並推動獲利成長時，這種調整將有助於提高透明度和問責制。

Of course, Tom and I will work closely with Steve Katrina and Andreana to scrutinize and support the underwriting and pricing decisions going forward.

當然，湯姆和我將與史蒂夫·卡特里娜和安德里亞娜密切合作，以審查和支持未來的承保和定價決策。

We've also been making operational changes, identifying and prioritizing those gaps and inefficiencies that create the most significant impacts to performance.

我們也一直在進行營運變革，確定對績效產生最重大影響的差距和低效問題並確定優先順序。

Our teams have been addressing the challenge of strain clinical operations by improving staffing and training.

我們的團隊一直在透過改善人員配備和培訓來應對應變臨床操作的挑戰。

We're utilizing technology to automate and streamline processes. For example, through the power of A I, we have simplified clinical case preparation and meaningfully reduce the amount of time our care managers spend on case prep, we are improving our services and claim operations, increasing our accuracy and reducing abrasion for members and providers.

我們正在利用技術來自動化和簡化流程。例如，透過人工智慧的力量，我們簡化了臨床病例準備，並有意義地減少了護理經理花在病例準備上的時間，我們正在改進我們的服務和索賠操作，提高我們的準確性並減少會員和提供者的磨損。

By utilizing technologies. We are driving greater insights across Aetna including expanded integration with the carear team to understand and manage pharmacy spend and enhance data insights to improve our ability to rapidly identify emerging utilization trends.

透過利用技術。我們正在 Aetna 推動更深入的洞察，包括擴大與護理團隊的整合，以了解和管理藥房支出並增強數據洞察力，以提高我們快速識別新興使用趨勢的能力。

The work in Aetna is underway and we are confident we are taking the right steps to address the underlying issues and drive improved performance. With Aetna turning to our pharmacy and consumer wellness business, we continue to effectively navigate a challenging and dynamic consumer backdrop.

Aetna 的工作正在進行中，我們相信我們正在採取正確的步驟來解決根本問題並提高績效。隨著 Aetna 轉向我們的製藥和消費者健康業務，我們將繼續有效地應對充滿挑戰和動態的消費者背景。

Our performance reflects strong execution and the benefit of strategic investments in our workflows and our colleagues this quarter, we achieved another record high retail pharmacy script share at 27.3% an impressive accomplishment as we continue to optimize our store footprint.

我們的業績反映了強大的執行力以及我們工作流程和同事的策略性投資的好處，本季我們的零售藥局腳本份額再創歷史新高，達到27.3%，隨著我們繼續優化我們的商店足跡，這是一項令人印象深刻的成就。

By the end of November, we will have completed our previously announced three year store optimization initiative targeting 900 stores and expect to close approximately 270 stores in 2025.

到 11 月底，我們將完成先前宣布的三年門市優化計劃，目標是 900 家門市，並預計在 2025 年關閉約 270 家門市。

We recognize the importance of retail pharmacy in the communities we serve and we continue to be thoughtful and deliberate as we execute on our footprint optimization efforts.

我們認識到零售藥局在我們所服務的社區中的重要性，並且在執行足跡優化工作時我們將繼續深思熟慮。

We are progressing our transition to the CBS cost manage model and have reached agreements covering more than half of our total commercial scripts.

我們正在推進向 CBS 成本管理模式的過渡，並已達成涵蓋商業劇本總數一半以上的協議。

The ongoing discussions with our large PB M partners remain active and constructive as we move forward with the full commercial contract implementation on January of 25.

隨著我們於 1 月 25 日推進全面商業合約的實施，與我們的大型 PB M 合作夥伴正在進行的討論仍然活躍且富有建設性。

We have also been deliberate in enhancing the durability and strength of our store operations to ensure we consistently serve our role as a community health destination.

我們也刻意增強商店營運的持久性和實力，以確保我們始終如一地發揮作為社區健康目的地的作用。

This was clear in the aftermath of the recent hurricanes. Our colleagues were instrumental in ensuring our operations were back online quickly with most stores open within 48 hours, we utilized our dynamic approach to workload sharing capability used across most of our fleet, allowing us to rapidly recover impact stores, ensure patient access to critical medications and provide continuity of care for our customers.

在最近的颶風過後，這一點變得很明顯。我們的同事在確保我們的營運快速恢復線上方面發揮了重要作用，大多數商店在48 小時內開業，我們利用動態方法來在我們的大多數車隊中使用工作負載共享功能，使我們能夠快速恢復影響商店，確保患者獲得關鍵藥物並為我們的客戶提供持續的護理。

In our pharmacy services business, we had another very strong quarter delivering on our commitments to our clients and customers.

在我們的藥局服務業務中，我們又一個非常強勁的季度兌現了我們對客戶和顧客的承諾。

In spite of the intense scrutiny and rhetoric that Caremark and the PB M industry face, we continue to play a crucial role in managing drug costs in this country.

儘管 Caremark 和 PB M 行業面臨嚴格的審查和言論，我們仍然在管理這個國家的藥物成本方面發揮著至關重要的作用。

I've highlighted the progress we made in the biosimilar space and our customers continue to see the value that we're delivering with our capabilities.

我強調了我們在生物相似藥領域的進展，我們的客戶繼續看到我們透過我們的能力提供的價值。

We are once again positioned to close out a robust selling season, achieving a retention rate. In the high 90s, we continue to offer our clients choice and innovation and our true cost offering is resonating in the market for 2025 clients, representing 70% of our commercialized have chosen to implement multiple elements of the true cost model and into their benefit design options.

我們再次準備好結束強勁的銷售季節，並實現保留率。在上世紀90 年代，我們繼續為客戶提供選擇和創新，我們的真實成本產品在2025 年客戶的市場中引起共鳴，代表我們70% 的商業化客戶選擇實施真實成本模型的多個要素並納入其效益設計選項。

And finally, our health care delivery business, we continue to progress our strategy of delivering superior care to the patients. We serve, signify, delivered another strong quarter at the members served by signify have nearly doubled compared to last year, supported by our ability to utilize touch points across CVS health.

最後，在我們的醫療保健服務業務方面，我們繼續推動為患者提供優質護理的策略。在我們利用 CVS health 接觸點的能力的支持下，signify 服務的會員人數比去年增加了近一倍，這又是一個強勁的季度。

Our enterprise connections also continue to accelerate patient growth at Oak Street. Our at risk membership is up 32% from the same quarter last year and the number of Aetna members enrolled at Oak Street has approximately quadrupled since the close of the acquisition through thoughtful benefit design. We continue to introduce Aetna members to high quality providers like Oak Street Health allowing us to improve member experiences and deliver better health outcomes.

我們的企業聯繫也持續加速橡樹街患者的成長。我們的風險會員數量比去年同期增加了 32%，透過深思熟慮的福利設計，自收購完成以來，在 Oak Street 註冊的 Aetna 會員數量增加了大約四倍。我們繼續向 Aetna 會員介紹 Oak Street Health 等優質提供者，使我們能夠改善會員體驗並提供更好的健康結果。

As we look ahead to 2025 and beyond, there are reasons to be optimistic and I'm excited about our path forward. We have implemented a disciplined approach to Medicare advantage benefit design.

展望 2025 年及以後，我們有理由保持樂觀，我對我們的前進道路感到興奮。我們對醫療保險優勢福利設計實施了嚴格的方法。

We continue to accelerate progress on our innovative pharmacy models and biosimilar strategy.

我們持續加快創新藥房模式和生物相似藥策略的進展。

We've delivered wins in both Caremark and that the selling season and we are rapidly advancing the integration of our health care delivery assets.

我們在 Caremark 和銷售季節都取得了勝利，我們正在快速推進我們的醫療保健服務資產的整合。

We are making the necessary changes to return our business to profitable growth. In 2025 we are committed to a disciplined financial policy and with improved profitability, expect to strengthen our balance sheet.

我們正在做出必要的改變，以使我們的業務恢復獲利成長。到 2025 年，我們致力於實行嚴格的財務政策，並提高獲利能力，預計將加強我們的資產負債表。

We have strong leadership across the country.

我們在全國範圍內擁有強而有力的領導。

We have a powerful collection of businesses operating in some of the most critical areas of health care which provide us with a unique opportunity to deliver value for our customers, colleagues and shareholders.

我們在醫療保健的一些最關鍵領域擁有眾多強大的企業，這為我們提供了獨特的機會，為我們的客戶、同事和股東創造價值。

I also want to extend our appreciation to our over 300,000 colleagues. I'm grateful for your continued dedication for our collaboration to drive continuous improvement and for all that you do every single day for the millions of customers and members we serve with that. I'll pass the call over to Tom Tom.

我還要向超過 30 萬名同事表示感謝。我感謝您為推動持續改善而持續致力於我們的合作，也感謝您每天為我們服務的數百萬客戶和會員所做的一切。我會把電話轉給湯姆湯姆。

Thank you David and thanks to everyone for joining us this morning. I'll start with a few highlights on total company performance.

謝謝大衛，也謝謝大家今天早上加入我們。我將首先介紹公司整體業績的一些亮點。

Third quarter, revenues were approximately $95.4 billion. An increase of approximately 6% over the prior year quarter. Primarily reflecting growth in our health care benefits and pharmacy and consumer wellness we delivered adjusted operating income of approximately $2.5 billion and adjusted EPS of a dollar nine year-to-date cash flow from operations were approximately $7.2 billion. A lower result as compared to the same period last year. Primarily due to the timing of C MS receipts and the impact of higher utilization on HCB earnings.

第三季營收約 954 億美元。較去年同期成長約 6%。主要反映了我們的醫療保健福利以及藥品和消費者健康方面的成長，我們的調整後營業收入約為25 億美元，調整後每股收益為9 美元，年初至今的營運現金流約為72 億美元。與去年同期相比，結果較低。主要是由於 C MS 收款的時間以及更高的使用率對 HCB 收益的影響。

Let's look at the performance in each of our segments in our health care benefits segment, we grew revenues to approximately $33 billion. An increase of over 25% year over year reflecting growth in all lines of business.

讓我們看看我們的醫療保健福利細分市場中每個細分市場的表現，我們的收入成長至約 330 億美元。年比成長超過 25%，反映了所有業務的成長。

Medical membership grew to approximately 27.1 million. An increase of 178,000 members. Sequentially, primarily reflecting growth in Medicare and individual exchange during the quarter. The segment generated an adjusted operating loss of $924 million. This result includes the impact of premium deficiency reserves of approximately $1.1 billion recorded primarily in our Medicare and individual exchange businesses. As a reminder PDRS generally measure variable losses in a product and do not contemplate fixed expenses.

醫療會員人數增至約 2,710 萬人。增加會員17.8萬人。其次，主要反映了本季醫療保險和個人交易的成長。該部門調整後營運虧損為 9.24 億美元。這一結果包括主要記錄在我們的醫療保險和個人兌換業務中的約 11 億美元保費不足準備金的影響。提醒一下，PDRS 通常衡量產品的可變損失，而不考慮固定費用。

The aggregate of the PDRS was comprised of approximately $670 million of health care costs and $394 million of operating expenses specifically related to the write off of unamortized, deferred acquisition costs substantially. All of the charges were associated with the 2024 policy here shifting the earnings cadence between the 3rd and 4th quarters.

PDRS 的總額包括約 6.7 億美元的醫療保健費用和 3.94 億美元的營運費用，特別是與未攤銷、遞延購置成本的註銷相關的營運費用。所有費用都與 2024 年政策有關，該政策將獲利節奏在第三季和第四季之間轉移。

Our medical benefit ratio of 95.2% increased 950 basis points from the prior year quarter including a 220 basis point impact from the PDRS. This increase was primarily driven by higher utilization, higher acuity and Medicaid. The premium impact of lower stars ratings for payment year 2024 and an update to our 2024 individual exchange risk adjustment. A quote, medical costs remain elevated in our Medicare book and at levels above what was contemplated in our previous guidance.

我們的醫療福利率為 95.2%，比去年同期增加了 950 個基點，其中包括 PDRS 的影響 220 個基點。這一增長主要是由更高的利用率、更高的敏銳度和醫療補助推動的。 2024 年付款年較低星級評級的保費影響以及我們 2024 年個人外匯風險調整的更新。引用一下，我們的醫療保險手冊中的醫療費用仍然很高，並且高於我們先前指導中預期的水平。

Pressure is largely attributable to the same categories we discussed last quarter including inpatient outpatient supplemental benefits and pharmacy.

壓力主要歸因於我們上季度討論的相同類別，包括住院門診補充福利和藥房。

During the third quarter, we also saw unfavorable development of 2024 medical costs primarily related to second quarter dates of service which has adversely impacted our trend outlook for the remainder of the year.

在第三季度，我們也看到 2024 年醫療成本的不利發展，主要與第二季的服務日期有關，這對我們今年剩餘時間的趨勢前景產生了不利影響。

Medical costs in our individual exchange business also accelerated during the quarter with broad levels of higher utilization above our prior expectations.

本季我們個人兌換業務的醫療成本也有所增加，利用率普遍高於我們先前的預期。

The pressure we've experienced thus far has been primarily driven by certain high cost geographies where the combination of our growth and metal tier mix have led to higher medical costs.

到目前為止，我們所經歷的壓力主要是由某些高成本地區造成的，在這些地區，我們的成長和金屬層組合的結合導致了更高的醫療成本。

During the third quarter. We also received updated risk adjustment data for individual exchange business.

第三季期間。我們也收到了個人交易所業務的最新風險調整數據。

As a result, we increased our risk adjustment accrual for the 2024 plan year by approximately $275 million in the quarter.

因此，我們在本季將 2024 年計畫年度的風險調整應計額增加了約 2.75 億美元。

We will continue to evaluate our revenue accruals for potential additional pressure as we receive updated data on our risk scores later this year and into early 2025 in our Medicaid business, consistent with others in the industry, we continue to experience higher acuity related to the impact of redeterminations.

我們將繼續評估我們的應計收入是否有潛在的額外壓力，因為我們收到了今年稍後和2025 年初醫療補助業務風險評分的最新數據，與業內其他公司一致，我們繼續體驗到與影響相關的更高敏銳度的重新決定。

We believe the level of dislocation between acuity and rates stabilized towards the end of the third quarter.

我們認為，敏銳度和利率之間的錯位水準在第三季末趨於穩定。

We continue to work closely with our state partners to align rates with changes in acuity. Although the engagement with our state partners has been constructive and we have seen some rate updates in the second half of 2024 they remain inadequate to cover current levels of elevated acuity.

我們繼續與我們的州合作夥伴密切合作，使費率與敏銳度的變化保持一致。儘管與我們的州合作夥伴的接觸是建設性的，並且我們在 2024 年下半年看到了一些費率更新，但它們仍然不足以覆蓋當前的敏銳度提高水平。

In light of the utilization pressures we have seen across the health care benefits segment. In 2024 we continue to closely watch our group commercial business to date. Pressures in this business have largely been manageable as we have proactively pushed rate to cover emerging medical cost trends.

鑑於我們在醫療保健福利領域看到的利用壓力。 2024 年，我們將繼續密切關注迄今為止的集團商業業務。由於我們積極提高費率以涵蓋新興的醫療成本趨勢，因此該業務的壓力基本上是可控的。

This will result in lower commercial risk membership in 2025 hindering our ability to grow earnings in this business days, claims payable at the end of the quarter was 44.6 days. Up 1.5 days, sequentially, primarily driven by the impact of the premium deficiency reserves.

這將導致 2025 年商業風險會員資格降低，阻礙我們在該工作日增加收入的能力，本季末應付索賠為 44.6 天。環比增長 1.5 天，主要是由於保費不足準備金的影響。

DC P was down 5.7 days from the prior year quarter. Primarily driven by growth in our Medicare business and the impact of increased pharmacy trends. We remain confident in the adequacy of our reserves.

DC P 較去年同期下降 5.7 天。主要由我們的醫療保險業務的成長以及藥品趨勢增加的影響所推動。我們對儲備充足性仍然充滿信心。

Our health services segment delivered another strong quarter. We generated revenue of $44.1 billion during the quarter. A decrease of approximately 6% year over year, primarily driven by the previously announced loss of a large client and continued pharmacy client price improvements.

我們的健康服務部門再次實現強勁的季度業績。本季我們的營收為 441 億美元。年比下降約6%，主要是由於先前宣布的大客戶流失以及藥房客戶價格持續上漲所致。

These decreases were partially offset by pharmacy drug mix. Increased contributions from our health care delivery assets and growth in specialty pharmacy adjusted operating income of approximately $2.2 billion increased 17% from the prior year quarter, reflecting improved purchasing economics partially offset by continued pharmacy client price improvements and the previously announced loss of a large client total pharmacy claims process in the quarter were approximately 484 million and total pharmacy services membership as of the end of the quarter was approximately 90 million.

這些下降被藥房藥物組合部分抵消。我們的醫療保健服務資產貢獻增加，專業藥房調整後營業收入約22 億美元，比去年同期增長17%，反映出採購經濟性的改善，但部分被藥房客戶價格的持續上漲和先前宣布的大客戶流失所抵銷本季藥局理賠流程總數約為 4.84 億，截至本季末藥局服務會員總數約為 9,000 萬。

We continue to be encouraged by the growth of our health care delivery assets. As David mentioned, signified continued its strong performance in the quarter generating revenue growth of approximately 37% over the prior year quarter.

我們的醫療保健服務資產的成長繼續令我們感到鼓舞。正如 David 所提到的，Signal 在本季持續保持強勁的業績，營收比去年同期成長約 37%。

Oak Street revenue increased significantly in the quarter growing approximately 36% driven by strong membership growth at risk. Members increased by approximately 32% compared to the same quarter last year, supported by our ability to use touch points across CBS health.

由於面臨風險的會員強勁成長，Oak Street 營收在本季大幅成長約 36%。由於我們在整個 CBS health 中使用接觸點的能力，會員數量與去年同期相比增加了約 32%。

We are encouraged by Oak Street's performance in this challenging environment.

我們對橡樹街在這個充滿挑戰的環境中的表現感到鼓舞。

During the quarter. Our pharmacy and consumer wellness segment generated revenue of approximately $32.4 billion. An increase of over 12% versus the prior year and over 15% on a same store basis.

本季期間。我們的製藥和消費者健康部門創造了約 324 億美元的收入。較上年成長超過12%，同店成長超過15%。

Adjusted operating income of nearly $1.6 billion increased approximately 15% versus the prior year driven by increased prescription volume including increased contributions from vaccines and improved drug purchasing, partially offset by continued pharmacy reimbursement pressure and lower front store volumes.

調整後的營業收入接近16 億美元，較上一年增長約15%，這是由於處方量增加（包括疫苗貢獻增加和藥品採購改善）所推動的，但部分被持續的藥房報銷壓力和較低的前置店銷量所抵銷。

Same store pharmacy sales in the quarter increased by nearly 20% versus the prior year and same store prescription volumes increased by approximately 9%.

本季同店藥局銷售額較前一年成長近 20%，同店處方量成長約 9%。

As David mentioned, we continue to grow our retail pharmacy script share position, achieving a share of approximately 27.3%.

正如 David 所提到的，我們繼續擴大零售藥房處方份額，實現約 27.3% 的份額。

Same store front store sales were down approximately 1% versus the same quarter last year.

同店前店銷售額與去年同期相比下降約 1%。

One other item I would like to highlight for investors is that we took a restructuring charge of nearly $1.2 billion in the quarter.

我想向投資者強調的另一件事是，我們在本季承擔了近 12 億美元的重組費用。

This amount reflects several components including impairment charges for approximately 270 stores. We expect to close in 2025 costs related to the discontinuation of non core businesses. And costs associated with workforce optimization shifting now to cash flow and the balance sheet.

這筆金額反映了多個組成部分，包括約 270 家商店的減損費用。我們預計在 2025 年結束與終止非核心業務相關的成本。與勞動力優化相關的成本現在轉移到現金流和資產負債表上。

Through our third quarter, we generated year-to-date cash flow from operations of approximately $7.2 billion. During the quarter, we returned $837 million to shareholders through our quarterly dividend. And we ended the quarter with approximately $1.2 billion of cash at the parent and unrestricted subsidiaries.

截至第三季度，我們年初至今的營運現金流約為 72 億美元。本季度，我們透過季度股息向股東返還 8.37 億美元。截至本季末，我們的母公司和不受限制的子公司擁有約 12 億美元的現金。

Our leverage ratio at the end of the quarter was approximately 4.6 times which is above our long term target.

本季末我們的槓桿率約為 4.6 倍，高於我們的長期目標。

We remain committed to maintaining our current investment grade ratings and expect our leverage to return to more normalized levels as we execute on margin recovery in the Aetna business.

我們仍然致力於維持目前的投資等級評級，並預計隨著我們執行安泰業務的利潤恢復，我們的槓桿率將恢復到更正常的水平。

As David mentioned, we are not providing a formal outlook for 2024 at this stage.

正如 David 所提到的，我們現階段並未提供 2024 年的正式展望。

However, we would like to provide some directional commentary to help you better understand how we see the moving parts starting with our health services and pharmacy and consumer wellness segments.

然而，我們希望提供一些定向評論，以幫助您更好地了解我們如何看待從我們的健康服務、製藥和消費者健康領域開始的變化部分。

As we have previously highlighted those businesses continue to deliver strong results in PC W while the immunization season got off to a stronger start than we expected. Shifting demand into the third quarter. Strong script growth continues to give us confidence in the previous outlook we shared with investors in the health services segment. Caremark's earnings progression in 2024 started slow but a steadily built momentum over the 2nd and 3rd quarters while we maintain a cautious outlook on our health care delivery business. As we evaluate the potential for additional Medicare trend related risk, we remain confident in our ability to deliver on the health services segment earnings outlook. We share with investors on our second quarter call within health care benefits. We continue to grapple with both environmental and company specific challenges as you have seen with our third quarter results similar to others within the industry. Medicare advantage utilization continues to be elevated.

正如我們之前強調的那樣，這些企業繼續在 PC W 中取得強勁業績，而免疫季節的開局比我們預期的要好。將需求轉移到第三季。強勁的劇本成長繼續讓我們對先前與醫療服務領域投資者分享的前景充滿信心。 Caremark 2024 年的獲利進展起步緩慢，但在第二季和第三季穩定成長，同時我們對醫療保健服務業務的前景保持謹慎。當我們評估額外醫療保險趨勢相關風險的潛力時，我們對實現醫療服務部門獲利前景的能力仍然充滿信心。我們與投資者分享了第二季醫療保健福利的電話會議。我們將繼續應對環境和公司特定的挑戰，正如您從我們第三季度的業績與行業內其他公司相似所看到的那樣。醫療保險優勢利用率持續提高。

We have also grown membership very rapidly with a very rich benefit offering which has resulted in benefit induced utilization.

我們也透過非常豐富的福利產品迅速增加了會員數量，這導致了福利誘導的利用。

Medicaid continues to be pressured by the dislocation between acuity and rates as well as seeing some pockets of higher utilization.

醫療補助繼續受到敏銳度和費率之間的錯位以及一些利用率較高的壓力。

We've also seen rapid growth in our individual exchange business which has led to several disappointing updates on risk adjusted revenue and in some states higher than expected utilization to date. The combination of these factors has challenged our visibility and our 2024 outlook.

我們還看到我們的個人兌換業務快速成長，這導致風險調整收入的幾次令人失望的更新，並且在某些州迄今為止的利用率高於預期。這些因素綜合起來對我們的能見度和 2024 年前景提出了挑戰。

While we are not providing formal guidance today, let me walk you through one potential scenario.

雖然我們今天不提供正式指導，但讓我帶您了解一個可能的情況。

If trends develop unfavorably and persist at the significant levels we have experienced in recent months. Our fourth quarter reported NBR could increase by over 700 basis points as compared to the fourth quarter of 2023.

如果趨勢發展不利並持續在我們近幾個月經歷的顯著水準。我們第四季的報告顯示，與 2023 年第四季相比，NBR 可能會增加 700 個基點以上。

Additionally, in this scenario, we would likely need to take AP Dr in our group Medicare advantage business related to 2025 dates of service which would further pressure 2024 results despite challenges in 2024 we have taken deliberate actions that position us for growth in 2025 and beyond.

此外，在這種情況下，我們可能需要在與2025 年服務日期相關的集團醫療保險優勢業務中取得AP 博士資格，這將進一步對2024 年業績構成壓力，儘管2024 年面臨挑戰，但我們已採取了深思熟慮的行動，為我們在2025 年及以後的成長奠定了基礎。

While we will not give formal 2025 guidance until next year when we have better visibility on our 2024 medical cost baseline and our changing membership. I want to provide an update on some of the key headwinds and tails starting first with the headwinds in our PC W segment. We expect earnings to decline in line with our long term guidance framework.

不過，直到明年我們才能更了解 2024 年醫療成本基準和不斷變化的會員資格時，我們才會提供正式的 2025 年指引。我想提供一些關鍵逆風和尾風的最新情況，首先從我們的 PC W 細分市場的逆風開始。我們預計盈利將根據我們的長期指導框架下降。

As David mentioned, we are encouraged by the adoption of CBS cost vantage and the shift of commercial scripts to this model. On January 1st, we expect 2025 to be a transition year that positions us for outperformance of our long term growth target in future years.

正如大衛所提到的，我們對哥倫比亞廣播公司成本優勢的採用以及商業劇本向這種模式的轉變感到鼓舞。 1 月 1 日，我們預計 2025 年將是一個過渡年，使我們能夠在未來幾年超越我們的長期成長目標。

We also remain cautious in our outlook for front store sales which have been pressured in recent quarters, consistent with the broader macro economic backdrop.

我們對前店銷售的前景也保持謹慎態度，前店銷售在最近幾季受到壓力，這與更廣泛的宏觀經濟背景一致。

As we previously discussed, we expect the return of certain variable corporate expenses.

正如我們之前討論的，我們預期某些可變企業費用會得到回報。

We also expect higher interest as we annualize the expense from our May 2024 financing, a decline in net investment income and modest dilution from the increase in our share count shifting now to the tailwinds, we expect improvement in contributions from our health care benefits segment.

我們也預計，隨著我們對2024 年5 月融資的費用進行年化計算，淨投資收入下降，並且我們的股票數量增加帶來的適度稀釋現在轉向順風，我們預計醫療保健福利部門的貢獻將有所改善。

We believe our deliberate approach to our 2025 Medicare advantage bids and our focus changes to our footprint, which we expect to result in membership disenrollment of 5 to 10% when combined with our improved star ratings will result in margin recovery.

我們相信，我們對2025 年醫療保險優勢投標的深思熟慮的方法以及我們對足蹟的關注點發生了變化，我們預計這將導致5% 至10% 的會員退出，再加上我們改進的星級評級，將導致利潤率恢復。

This is a significant first step on our journey back to target margins of 3 to 5%.

這是我們回歸 3% 至 5% 目標利潤率的重要第一步。

We continue to view the dislocation between acuity and rates and Medicaid as temporary and expect this to be resolved over subsequent pricing cycle.

我們仍然認為敏銳度、費率和醫療補助之間的錯位是暫時的，並預計這一問題將在隨後的定價週期中得到解決。

However, we do not expect the dislocation to be fully resolved. Before the end of 2025.

然而，我們並不期望這種錯位能夠完全解決。 2025年底前。

We expect improvement in our individual exchange business as a result of our pricing actions and deliberate product repositioning which we project will decrease membership in this block of business. In 2025 we will continue to refine our product offerings for long term sustainability.

我們預計，由於我們的定價行動和有意的產品重新定位，我們的個人交易所業務將得到改善，我們預計這將減少該業務領域的成員數量。 2025 年，我們將繼續完善我們的產品，以實現長期永續發展。

We also expect underlying growth in our health services business including growth in pharmacy services as we continue to drive value for our clients and incremental improvement in our health care delivery businesses.

我們也預期我們的健康服務業務將實現潛在成長，包括藥局服務的成長，因為我們將繼續為客戶創造價值，並逐步改善我們的醫療保健服務業務。

We expect our initial outlook for this segment will be below our long term growth framework, but we prudently provide opportunities for upside over the course of the year.

我們預計該細分市場的初步前景將低於我們的長期成長框架，但我們將謹慎地提供全年的上行機會。

Finally, we have executed the first step of our multi year cost savings initiative that we expect will generate over $500 million next year helping to offset the return of variable expense in 2025.

最後，我們已經執行了多年成本節約計畫的第一步，預計明年將產生超過 5 億美元的收入，有助於抵銷 2025 年可變費用的回報。

Taking a step back 2024 has been a disappointing year for performance in our health care benefits segment, we could experience mid single digit percentage losses in our Medicare business.

退一步來說，2024 年對於我們的醫療保健福利部門的表現來說是令人失望的一年，我們的醫療保險業務可能會出現中個位數百分比的損失。

Our foray into the individual exchange business could result in negative margins that approach double digits.

我們進軍個人兌換業務可能會導致接近兩位數的負利潤。

We're also projecting modest negative margins in our Medicaid business.

我們也預期醫療補助業務將出現適度的負利潤。

It is possible that our health care benefits business could show operating losses in 2024 after generating over 5.5 billion of adjusted operating income in 2023.

我們的醫療保健福利業務在 2023 年產生超過 55 億調整後營業收入後，到 2024 年可能會出現營業虧損。

Conversely, this means that there are well over $3 of embedded adjusted EPS. If we could return aetna profitability to 2023 levels.

相反，這意味著嵌入調整後每股收益遠遠超過 3 美元。如果我們能讓安泰的獲利能力恢復到 2023 年的水準。

Open enrollment for both Medicare advantage and individual exchange has demonstrated that we took meaningful action in curtailing benefits, adjusting products and where appropriate raising prices.

醫療保險優勢和個人交換的公開註冊表明，我們在削減福利、調整產品以及適當提高價格方面採取了有意義的行動。

Well, we are confident we have taken the right initial actions. The road to recovery will take time.

嗯，我們相信我們已經採取了正確的初步行動。復甦之路需要時間。

We look forward to providing more details on our 2025 outlook and those first steps on our journey and we have more clarity on the moving parts in our health care benefits business. Next year.

我們期待提供有關 2025 年展望以及我們旅程中的第一步的更多詳細信息，並且我們對醫療保健福利業務中的動態部分有更清晰的了解。明年。

With that, we'll now open the call to your questions, operator.

這樣，接線員，我們現在將開始詢問您的問題。

Thank you. We will now begin the question and answer session.

謝謝。我們現在開始問答環節。

If you would like to ask a question, please press star followed by one on your telephone keypad.

如果您想提問，請按下電話鍵盤上的星號，然後再按一個。

As a reminder. If you were using a speaker phone, please remember to pick up your handset before asking a question. We'll pause here briefly whilst questions are registered.

作為提醒。如果您使用免持電話，請記得在提問前拿起聽筒。我們將在這裡短暫暫停，同時登記問題。

We have the first question on the phone lines from Lisa Gill with JP Morgan. You may proceed.

第一個問題是麗莎·吉爾（Lisa Gill）透過電話與摩根大通（JP Morgan）聯繫的。您可以繼續。

Great. Thanks very much and thanks for the detail. Tom, I just wanted to make sure that I understand a couple of things. One when I think about the ma bids that you put in for, for 2025 you you talked about and we also saw on the, the plan finder, you know that the cuts, can you maybe just talk about? I know we're only one month in, but are you seeing the disenrollment that you expected? And to just given the size of the surprise that we've seen here in the back half of the year? You know, the level of confidence that you have around the the bids that you did put in for for 2025 if, if I can understand that. And then just secondly, you know, you talked about pharmacy, we've heard others talk about pharmacy trends here in the back half of the year, really shifting and changing because of the Inflation Reduction Act and changes around catastrophic coverage. Just curious. One, did you see that as well? Specific to those changes? And is it benefiting perhaps some of the other sides of your business? I know you obviously have a really big specialty business and you talked about the strength in the pharmacy business.

偉大的。非常感謝並感謝您的詳細資訊。湯姆，我只是想確保我理解一些事情。一是當我想到你為 2025 年提出的主要投標時，你談到了，我們也在計劃查找器上看到，你知道削減，你可以談談嗎？我知道我們才上線一個月，但是您是否看到了預期的退出情況？考慮到今年下半年我們在這裡看到的驚喜有多大？你知道，如果我能理解的話，你對 2025 年投標的信心程度。其次，你知道，你談到了藥房，我們聽到其他人談論今年下半年的藥房趨勢，由於通貨膨脹減少法案和災難性保險的變化，藥房趨勢確實發生了變化。只是好奇。一、你也看到了嗎？具體有那些變化？它是否有利於您業務的其他方面？我知道您顯然擁有非常大的專業業務，並且您談到了製藥業務的實力。

Great. Let me start with your first question. So, we're early in the open enrollment season. But, you know, I did reiterate the guidance that we've been giving for a couple of months. Now, our early indicators would suggest that we would be down that in that 5 to 10% range on the total book and we'll have more stability on the group book so that the higher percentages think about the individual and the dual eligible populations that we'll see declines on. But we feel, you know, reasonably good about, how the membership is coming in and that it would be within that range that we've been guiding investors to.

偉大的。讓我從你的第一個問題開始。所以，我們正處於公開招生季節的早期。但是，你知道，我確實重申了我們幾個月來一直給予的指導。現在，我們的早期指標表明，我們將在總賬簿上的 5% 到 10% 範圍內下降，並且我們將在團體賬簿上更加穩定，以便更高的百分比考慮個人和雙重合格人群我們會看到下降。但我們覺得，你知道，我們對會員的加入情況相當滿意，而且它會在我們一直引導投資者的範圍內。

A as you think about ability and confidence in the bids. The bids are, are clearly designed to improve results next year. And maybe there's a couple of things I can, I can talk you through at a high level just to give you a framework to think about that. The first is improvement in stars. And so because of the, the, you know, the contracts that we have that are now going to be four stars or better for 2025 payment year, that's going to be about an $800 million headwind. No matter what the baseline is. Oh, excuse me, tailwind, I keep doing that. It used to be a tailwind, a headwind and now it's going to be a tailwind next year. The, on the individual blocks of business. We have made a deliberate benefit design changes to supplemental benefits which will fundamentally change how these benefits function in 2025 which will also improved margins. Finally, we've both exited underperforming counties and we've pulled underperforming products that will impact nearly half a million members. Those changes should also improve profitability in 25. As many of those members will choose newly designed products that will have an improved margin profile. You know, we expect that those changes are going to drive margin expansion and we have when we have a better understanding of what that membership mix looks like for 2025 as well as our 24 baseline, we'll be able to better provide specifics on the level of anticipated improvement improvement next year.

A 當您考慮投標的能力和信心時。這些投標顯然是為了改善明年的業績。也許我可以做一些事情，我可以在高層次上向您介紹，只是為了給您一個思考這個問題的框架。首先是星級的提升。因此，由於我們現在擁有的合約在 2025 年付款年將達到四星或更好，這將帶來約 8 億美元的阻力。不管底線是什麼。哦，對不起，順風，我一直都這樣做。過去是順風，逆風，現在明年將是順風。 ，關於各個業務塊。我們對補充福利進行了有意的福利設計變更，這將從根本上改變這些福利在 2025 年的運作方式，同時也將提高利潤率。最後，我們都退出了表現不佳的縣，並撤回了表現不佳的產品，這些產品將影響近 50 萬名會員。這些變化也應提高 25 的獲利能力。您知道，我們預計這些變化將推動利潤率擴張，當我們更好地了解 2025 年的會員組合以及我們的 24 基線時，我們將能夠更好地提供有關明年的預期改善水平。

Yes, Lisa, this is David. Maybe just 11 additional follow on here. I I think one is we are feeling very good about the improvements that we've made going into 25. So the recognizing obviously the challenge in 24 we had, we believe we made the appropriate course correction and then as it relates to pharmacy, which was your last question. I think this is the unique opportunity of this enterprise. We, the goal here is not to be surprised, especially as it relates to the pharmacy costs, we think we've anticipated and contemplated the changes both at IRA as well as the broader macro trends that we see within pharmacy and the goal here, especially with now with the addition of both Steve and Prem, we're going to see further integration of not just the pharmacy benefit integration, but more importantly that the medical pharmacy, which is a piece that obviously I think is is driving some of the some of the increased cost in the back of the year.

是的，麗莎，這是大衛。也許這裡還有 11 個額外的關注。我認為其中之一是我們對進入25 年後所做的改進感覺非常好。這是你的最後一個問題。我認為這是這個企業獨特的機會。我們，這裡的目標並不令人驚訝，特別是因為它與藥品成本相關，我們認為我們已經預期並考慮了 IRA 的變化以及我們在藥房內看到的更廣泛的宏觀趨勢和這裡的目標，特別是現在隨著Steve 和Prem 的加入，我們將看到不僅是藥房福利整合的進一步整合，更重要的是醫療藥房的整合，我認為這顯然正在推動一些今年下半年增加的一些成本。

Thank you. As a reminder, we do ask that you please limit yourself to one question and one follow up. If you have any further to please rejoin the queue. We have our next question from Justin Lake with Wolfe research. Your line is open.

謝謝。提醒一下，我們確實要求您將自己限制在一個問題和一個後續行動上。如果您還有任何疑問，請重新加入隊列。我們的下一個問題來自賈斯汀·萊克和沃爾夫研究。您的線路已開通。

Thanks. Good morning. First just wanted to clarify the four Q commentary to that you said is potentially up 700 basis points or I'm getting to about 95.5%. MLR, does that include the 3D 3 QPDR and the potential Medicare Advantage PDR you mentioned? And then more importantly, how should we think about framing 2024 run rate earnings into 2025? Trying to understand, you know, your, your mor looks like it's obviously a lot higher in the third quarter and going to be a lot higher in the fourth quarter. Do we need to run rate that and back into the first half? So let's just say 75¢ of earnings kind of decline just trying to understand the, the run rate versus, you know, you're going to report a number for 2024. But what's the real run rate that we jump off of into 2025. Is there a framework to think about that? Thanks.

謝謝。早安.首先，我想澄清一下您所說的可能上漲 700 個基點或我將達到約 95.5% 的 4 Q 評論。 MLR，這是否包括您提到的 3D 3 QPDR 和潛在的 Medicare Advantage PDR？更重要的是，我們應該如何考慮將 2024 年的運行率收益納入 2025 年？試著去理解，你知道，你的、你的 mor 看起來第三季明顯要高得多，第四季也會高得多。我們需要在上半場進行評估嗎？因此，我們假設收益下降了 75 美分，只是想了解運行率與您將報告 2024 年的數字相比。謝謝。

Yeah, Justin, let me, let me touch on some of your other questions first. But I think part of the question that we need to answer and that I think you need to ask yourself is how much of this benefit. And with this trend that we're seeing is because of the benefits that we put out into the market. And what kind of utilization is being induced because of that? What kind of membership did we attract? And how much will that profile change with changing benefits next year? And that's part of the open question to your the open question in answering your question that I think we want to take a little bit more time to understand. But on your MLR specific comments, that is inclusive of the release of the PDR that you could see that 700 basis point increase, but not necessarily inclusive of AP Dr and group, which will depend on a variety of factors. But let me walk you through. Give you a little bit more commentary and color on what we outlined here. First, I think it's important to just continue to reiterate. We feel very good about our ability to achieve the guidance we gave last quarter on both the PC W and the health services segments. So the open question here is health care benefits for our larger lines of business. Second quarter trend appears to be the high point. But the third quarter, dates of service are still immature. So there are three components to the scenario that we laid out first across all of our major business lines. We assume that third quarter trends would develop unfavorably moving them to the highest levels we've seen over the last few months and then assuming that they persisted at those levels throughout the fourth quarter.

是的，賈斯汀，讓我先談談你的其他一些問題。但我認為我們需要回答並且你需要問自己的部分問題是這種好處有多少。我們看到的這種趨勢是因為我們投入市場的好處。因此會引發什麼樣的利用？我們吸引了什麼樣的會員？隨著明年福利的變化，這種情況會發生多大變化？這是回答您的問題時所提出的開放性問題的一部分，我認為我們需要多花一點時間來理解。但就國土資源部的具體評論而言，這包括了 PDR 的發布，您可以看到增加了 700 個基點，但不一定包括 AP 博士和團體，這將取決於多種因素。但讓我帶您了解一下。為您提供更多關於我們在此概述的內容的評論和色彩。首先，我認為繼續重申很重要。我們對實現上季度 PC W 和醫療服務領域的指導的能力感到非常滿意。因此，這裡的懸而未決的問題是我們更大的業務範圍的醫療保健福利。第二季的趨勢似乎是高點。但第三季的服務日期仍不成熟。因此，我們首先在所有主要業務線中列出了該場景的三個組成部分。我們假設第三季的趨勢將不利地發展到我們在過去幾個月中看到的最高水平，然後假設它們在整個第四季度持續保持在這些水平。

Second, we assume we saw further deterioration in our risk adjustment, accruals on our individual exchange business in the fourth quarter. Call it an additional point on gross revenue.

其次，我們假設第四季度個人交易所業務的風險調整和應計費用進一步惡化。稱其為總收入的附加點。

Third, we made a provision that there could be some modest induced utilization particularly in Medicare as individuals looked at their changing benefits in 25 and seek to utilize benefits that will no longer be available next year.

第三，我們做出了一項規定，可能會出現一些適度的誘導利用，特別是在醫療保險方面，因為個人會考慮 25 年內不斷變化的福利，並尋求利用明年將不再提供的福利。

You know, and then finally, we noted the group Medicare trend levels that if they persisted at that level, I just referenced, that could cause us to take an additional PDR in the fourth quarter. But that will really depend on, you know, how, what we think the baseline is for 24 and how it is that that's going to persist into 25. So more to come on that, I would note finally, our reserve balances through October, they have been modestly positive. But we've continued to see pressure in the more recent dates of service, for example, the third quarter.

你知道，最後，我們注意到集團醫療保險趨勢水平，如果他們持續保持在這個水平，我剛才提到，這可能會導致我們在第四季度採取額外的 PDR。但這實際上取決於，你知道，我們認為 24 的基線是什麼，以及它將如何持續到 25。的積極態度。但我們在最近的服務日期（例如第三季）繼續看到壓力。

Thank you. We now have Steven Baxter with Wells Fargo. Please go ahead when you're ready.

謝謝。現在我們有富國銀行的史蒂文·巴克斯特。準備好後請繼續。

Yeah, hi, thanks.

是的，嗨，謝謝。

I just a couple of quick ones. So you did mention that in response to that question. It's important to differentiate the incremental trend that's coming out of benefits that have already been restructured for 2025 versus more potentially core areas of utilization. So maybe could you help us understand better what you saw in the third quarter? And then just on the PDR commentary for 2025 you, you're saying you potentially need one for group ma, but you're not saying you need one for individual ma or potentially the exchanges just wondering why or why not? That would be the case. Thank you.

我只是快速的幾個。所以你在回答這個問題時確實提到了這一點。區分 2025 年已經重組的收益與更多潛在核心利用領域的增量趨勢非常重要。那麼您能否幫助我們更了解您在第三季看到的情況？然後，就 2025 年 PDR 評論而言，您說您可能需要為團體 ma 提供一個，但您並不是說您需要為個人 ma 提供一個，或者可能交易所只是想知道為什麼或為什麼不？事情就是這樣。謝謝。

Let me answer the second part first. So the way the PDRS are calculated is partially based on how those products are sold. And so our individual Medicare products are differently group than how our group Medicare products are. And as you can imagine, the nature of the contracts in the group business tends to be multi year. And so there's less ability to make improvement year over year. And so that business has a different profile going into 25 than the individual business in Medicare does or the individual exchange business does. You know, we haven't really talked a lot about the exchange business, but you know, that's a $10 billion block of revenue in 2024 with over 1.9 million members. You know, as David noted, we unfortunately grew that business too fast. We're suffering significant losses in 24 mostly led by our sep members. This pressure was compounded by unfavorable metal product mix which skewed to certain geographies. You know, we have taken as I believe we previously discussed double digit rate increases across this book for next year. And as a deliberate consequence of that rate action, we expect we could shrink that book by as much as 20 to 25% next year. So those actions combined with some of the operational improvements that the teams are making on the ground should also help to improve performance next year. Which is part of the reason that at this point, we don't anticipate that we would need AP dr in that individual business.

我先回答第二部分。因此，PDRS 的計算方式部分取決於這些產品的銷售方式。因此，我們的個人醫療保險產品與我們的團體醫療保險產品的分組方式不同。正如您可以想像的那樣，集團業務中的合約性質往往是多年期。因此，逐年改進的能力就會減弱。因此，進入 25 後，該業務的概況與 Medicare 中的個人業務或個人交換業務不同。你知道，我們還沒有真正談論過交易所業務，但你知道，到 2024 年，這將是一個 100 億美元的收入，擁有超過 190 萬會員。你知道，正如大衛指出的那樣，不幸的是我們的業務成長得太快了。我們在 24 年遭受了重大損失，主要是由我們的 sep 成員領導的。這種壓力因偏向某些地區的不利金屬產品結構而加劇。你知道，我們已經採取了我相信我們之前討論過的明年本書中兩位數的利率增長。作為該利率行動的故意後果，我們預計明年我們可能會將該帳簿縮減多達 20% 至 25%。因此，這些行動與團隊在實地進行的一些營運改善相結合，也應該有助於提高明年的績效。這是目前我們預計在該個別業務中不需要 AP 博士的部分原因。

As it relates to trend, we have continued to see supplemental benefit trends be elevated throughout all of 2024 and that persisted into the third quarter where we've also seen trend pressure. As I noted in the prepared remarks has been in all the usual suspects this year. It's been in patient, it's been an outpatient, although the types of procedures that we've seen have shifted somewhat, We continue to see pressure on things like medical pharmacy, you know, particularly on some of the oncology, drugs. And so it's it's a lot of the same things that we have been talking about throughout the whole year. The piece that I was mentioning in terms of the bridge is there is a, you know, a large portion of that trend increase that is a function of some of the supplemental benefits that we have offered. And those have been fundamentally restructured next year for individual, you know, Medicare products. And we'll give you better insight as to what that was worth when we have a better sense as to how the mix has come out and what the baseline is for 24.

由於與趨勢相關，我們繼續看到補充福利趨勢在 2024 年全年都在上升，並且這種情況持續到第三季度，我們也看到了趨勢壓力。正如我在準備好的演講中指出的那樣，今年所有的情況都是常見的。它是在病人身上，它是在門診病人身上，儘管我們看到的手術類型已經有所改變，我們仍然看到醫療藥學等方面的壓力，你知道，特別是在一些腫瘤學、藥物方面。因此，我們一整年都在談論很多相同的事情。我在橋樑方面提到的部分是，你知道，趨勢成長的很大一部分是我們提供的一些補充福利的函數。明年，這些產品將針對個人醫療保險產品進行根本重組。當我們更了解混合結果以及 24 的基線是什麼時，我們會讓您更了解它的價值。

And Steven, this is David, maybe just a quick follow on here. This is the third question on the Q4 jump off. And I, I think it's important to recognize that we, we know what the problems are. The you know, clearly, we, we've stated them in the prepared remarks, we understand kind of the broader issues that is that are, that are challenging the 24 performance. The good news is we're proactively addressing those as we, as you've seen in terms of how we structured the product design and the benefits. You've seen changes in how we've structured, our leadership teams, seen changes in terms of how we structured our our risk management and pricing controls. So we believe that we're on the path of actually getting to to an improved performance and so quickly we can move past 24 and into 25. I think the better we'll we'll continue to be for the collective group.

史蒂文，這是大衛，也許只是這裡的快速跟進。這是第四季開始的第三個問題。我認為重要的是要認識到我們知道問題是什麼。你知道，很明顯，我們已經在準備好的發言中闡述了這些問題，我們了解一些更廣泛的問題，這些問題正在挑戰 24 日的表現。好消息是，正如您在我們如何建立產品設計和優勢方面所看到的那樣，我們正在積極解決這些問題。您已經看到了我們的領導團隊的結構方式的變化，也看到了我們風險管理和定價控制結構方式的變化。因此，我們相信我們正走在真正提高績效的道路上，很快我們就能超越 24 名並進入 25 名。

Thank you. We now have Michael journey with Lein partners. Please go ahead.

謝謝。我們現在有 Michael 與 Lein 合作夥伴的旅程。請繼續。

Good morning and thanks for all the color, you know, maybe I'll, I'll try and take this a different direction and talk about pharmacy services. You talked about Tom next year being a bit below long term plan. Can you break that down within the health service segment between services versus the health delivery assets and specific type of pharmacy services? How are you thinking about both special utilization as well as the continued contribution of CORS as you sit here today, thinking through where the jump off point, official 25 again for the health services segment. Can go.

早上好，感謝所有的顏色，你知道，也許我會，我會嘗試採取不同的方向並談論藥房服務。您談到湯姆明年的表現略低於長期計畫。您能否在醫療服務領域內將其細分為服務與醫療服務資產和特定類型的藥房服務之間的關係？當您今天坐在這裡思考健康服務領域的起點（官方再次發布 25 號）時，您如何看待 CORS 的特殊利用以及 CORS 的持續貢獻。可以走了。

Thanks Mike. The did you think about the health services segment? We got a little bit of a slow start in 2024. But that business, you know, that that team has done an exceptional job of really driving momentum and we've seen that momentum accelerate into the second and into the third quarters, which has really given us a lot of confidence in the outlook as we think about this year. As we think about next year, I'd say given that slow start, we don't want to get ahead of ourselves. And so, you know what, we're not providing formal guidance today, we want to make sure that we appropriately set expectations. Given how that was a little bit choppy out of the gates last year.

謝謝邁克。您有考慮過醫療服務領域嗎？我們在 2024 年的起步有點緩慢。前景時，確實給了我們很大的信心。當我們考慮明年時，我想說，鑑於開局緩慢，我們不想超越自己。因此，您知道嗎，我們今天不提供正式指導，我們希望確保我們適當地設定期望。考慮到去年的情況有點不穩定。

And this is David obviously now a division I know much better in terms of the performance. And I will say we, we, we're going to finish 24 strong. And if you look at the 25 year, we're actually heading into a really strong selling season trend amount of momentum as it relates to the success we've had on the biosimilar launch. I'm changing and disrupting the market as it relates to pricing models. This client satisfaction and member NPS scores are as high as they've been. So I believe just collectively on this business is running really well and still feel very strong about his continued performance into 25.

顯然，這就是大衛，現在我在表現方面更加了解這個部門了。我想說的是，我們、我們、我們將進入 24 強。如果你看看 25 年，我們實際上正在進入一個非常強勁的銷售季節趨勢量，因為這與我們在生物相似藥上市方面的成功有關。我正在改變和擾亂與定價模式相關的市場。客戶滿意度和會員 NPS 分數與以往一樣高。因此，我相信，從整體上看，這項業務運作得非常好，並且對他在 25 歲的持續表現感到非常滿意。

Thank you.

謝謝。

We now have Josh Raskin with Nurofen Research. Your line is open.

我們現在邀請了布樂芬研究中心的喬許‧拉斯金 (Josh Raskin)。您的線路已開通。

Hi, thanks, good morning. Just a clarification on the PDR time. So I want to make sure I understood what you said that no PDR has been contemplated for 2025. So Ma and Hicks lost money in totality in 24 and will be positive in 2025. I just want to make sure we got that right. And then more importantly, can you speak to your updated Medicare, both MA and PDP distribution strategy and I'm specifically interested in your commission strategy with external brokers and feedback you guys are getting on that.

嗨，謝謝，早安。只是對 PDR 時間進行澄清。所以我想確保我理解你所說的，即 2025 年不會考慮 PDR。更重要的是，您能否談談您更新的 Medicare、MA 和 PDP 分配策略，我對您與外部經紀人的佣金策略以及您收到的反饋特別感興趣。

Thanks Josh. On the PDR, the PDR is a pretty esoteric accounting rule. And so it looks at the business and looks at it on a variable cost basis. And as we look at and think about our projections for next year, we with the improvements that we are expecting in across those books, the only one we think might be close to the line is the Group Medicare business, which is why we highlighted that for investors. But I wouldn't take that to mean that we are necessarily going to be profitable because you have to allocate out those fixed costs, which are fairly substantial as you think about the fixed costs associated with those two large businesses. As you think about our strategy, for both MA and PDP, you know, we are going to shrink membership in PDP. We do use a lot of broker channels only about 15% of what we do is actually from internal channels. The rest of it is from external channels where we have large long and you know, established relationships. You know, we're generally very pleased with where it is that our early sales are coming out. We're obviously throughout this process of open enrollment, we make tweaks to that as we look at where geographies are coming in and think about where we want to grow and where we might want might not want to grow as quickly. But overall, you know, where A EP is coming out as of, you know, the end of last week is very consistent with where we had mapped it. Maybe a little bit of mix, you know, difference, but generally in line with, you know, in the aggregate with where we had thought about it. And so we were pretty pleased with the performance to date.

謝謝喬希。關於PDR，PDR是一個相當深奧的會計規則。因此，它會以可變成本為基礎來審視業務。當我們審視並思考對明年的預測時，隨著我們對這些帳簿的預期改進，我們認為唯一可能接近目標的是集團醫療保險業務，這就是為什麼我們強調這一點對投資者來說。但我並不認為這意味著我們一定會獲利，因為你必須分配這些固定成本，當你考慮到與這兩家大型企業相關的固定成本時，這些固定成本相當可觀。當你思考我們的策略時，對於 MA 和 PDP，你知道，我們將減少 PDP 的成員數量。我們確實使用了很多經紀商管道，但實際上我們所做的工作中只有大約 15% 來自內部管道。其餘部分來自外部管道，我們在這些管道中擁有大量長期且已建立的關係。您知道，我們通常對早期銷售的結果感到非常滿意。顯然，我們正在經歷整個開放註冊的過程，當我們關注哪些地區正在進入並思考我們想要在哪些地區發展以及我們可能想要哪些地區可能不希望快速增長時，我們會對此進行調整。但總的來說，你知道，上週末發行的 EP 與我們繪製的位置非常一致。也許有一點混合，你知道，差異，但總的來說，你知道，與我們的想法一致。所以我們對迄今為止的表現非常滿意。

We now have Elizabeth Anderson with Ethical. I si.

現在伊麗莎白·安德森 (Elizabeth Anderson) 與《道德》雜誌 (Ethical) 合作。我是。

Hi guys. Thanks so much for the question this morning. Maybe just one question about the PDR OpEx mechanics that you guys talked about in the third quarter, the third quarter PDR. Does those, does that from an OpEx perspective? Does that flip and become a positive to your numbers in the fourth quarter? That'd be my first question. And then secondarily, can you just maybe dig in a little bit more on the PC W strength? How do we expect sort of that cadence to change as we think about the pull forward from COVID and then any kind of seasonality you guys are thinking about for the fourth quarter? Thank you.

嗨，大家好。非常感謝今天早上的提問。也許只是你們在第三季談論的 PDR OpEx 機制的一個問題，即第三季 PDR。從營運支出的角度來看，這些是嗎？這是否會扭轉並為您第四季度的數據帶來正面的影響？這是我的第一個問題。其次，您能否進一步挖掘 PC W 的優勢？當我們考慮到新冠疫情的影響以及你們正在考慮的第四季度的季節性因素時，我們預計這種節奏會如何改變？謝謝。

Maybe I'll take the PDR mechanic and then prem you can talk a little bit about the PC wra on, on the PDR mechanic. The way that this works is that you look at what the potential losses might be on a variable basis. You record the PDR and really how you record it is that one of the first places you have to look is you have to look at any deferred acquisition cost that you have hung up on the balance sheet. And so you, you accrue for that, you take those down first. That means that while you're not really reversing a reserve, you don't have expense that you otherwise would have anticipated having in the fourth quarter. So it is an expense benefit and an MLR benefit. So the vast majority of that $1.1 billion will come back in the fourth quarter.

也許我會講一下 PDR 機制，然後你可以談談 PDR 機制上的 PC 框架。其工作原理是，您在可變的基礎上查看潛在的損失。您記錄 PDR，實際上您如何記錄它，您首先要查看的地方之一是您必須查看掛在資產負債表上的任何遞延購置成本。所以你，你為此累積了，你先把它們記下來。這意味著，雖然您並沒有真正沖銷準備金，但您沒有預期在第四季度產生的費用。因此，它既是費用收益，也是 MLR 收益。因此，這 11 億美元中的絕大多數將在第四季度收回。

And, and I have AP C DPC W strength, I'd say a few things. First and foremost, we had a really strong quarter. Part of that was driven by immunization season coming for coming sooner than we expected, started in mid August versus, you know, later in that month or early September. And we, we had a first market mover there. We were ready for that. Our teams were prepared. We've been preparing for that season, you know, for, for the most part of the year. The second piece I would say is around our core service levels continue to remain very strong. We've continued to improve MP S levels are up, you know, hundreds of basis points year over year. And that's turning into what I would say, a strong script growth as it relates to our, our pharmacy business. Now, around 27.3% up, you know, 70 plus basis points year over year So another great example of the strong service driving script growth in our pharmacy segment of that business and on the front store as, as tom alluded to there was, you know, some front store pressure, but our front store business continues to improve, you know, in a difficult market in a difficult market environment. And we continue to do the right things around focusing on gaining customers and increasing foot traffic on on that business as we go into it and really kind of mitigating some of the challenges we had early in the year. So, but the PC W segment really proud of our results, really proud of the leadership team and all the results that you've driven in that area. And you know, it's continued to be a strength of our business.

而且，我有 AP C DPC W 實力，我想說幾件事。首先也是最重要的，我們有一個非常強勁的季度。部分原因是免疫季節來得比我們預期的要早，從八月中旬開始，而不是當月晚些時候或九月初。我們在那裡有第一個市場推動者。我們已經準備好了。我們的團隊已經做好準備了。你知道，我們一年中的大部分時間都在為這個賽季做準備。我要說的第二點是我們的核心服務水準持續保持非常強勁。我們不斷提高 MP S 水平，您知道，比去年同期上升了數百個基點。我想說的是，這正在變成與我們的製藥業務相關的強勁的劇本成長。現在，增長了 27.3% 左右，同比增長了 70 多個基點。你知道，一些前置店壓力很大，但是我們的前置店業務持續改善，你知道，在困難的市場環境下。當我們進入該業務時，我們將繼續圍繞贏得客戶和增加該業務的客流量做正確的事情，並真正減輕我們在今年年初遇到的一些挑戰。所以，PC W 部門真的為我們的成果感到自豪，為領導團隊以及你們在該領域取得的所有成果感到自豪。你知道，它仍然是我們業務的優勢。

And this is David, maybe just to reinforce Prem's point here. Obviously, the retail sector is, is pressured. Lots of headwinds in this time in this market. And if you look at what Prem and the team have been able to deliver and execute is really incredibly impressive. Share growth while you're contracting a footprint service levels are, are up. And this is kind of all despite obviously pressures around around this sector. So I'm incredibly excited about prems expansion of his role and responsibility to take that same focus on execution and operational excellence into the broader our broader business.

這是大衛，也許只是為了強化普雷姆的觀點。顯然，零售業正在承受壓力。目前這個市場面臨很多阻力。如果你看看 Prem 和團隊所交付和執行的成果，確實令人印象深刻。當您簽訂合約時，共享成長服務水準正在上升。儘管該行業面臨明顯的壓力，但這就是全部。因此，我對 prems 擴大他的角色和責任感到非常興奮，他將同樣專注於執行和卓越營運擴展到我們更廣泛的業務。

Thank you. We now have Andrew Mok with Barclays, please Go ahead.

謝謝。現在我們有巴克萊銀行的安德魯·莫克（Andrew Mok），請繼續。

Hi, good morning. Wanted to follow up on Medicare advantage margins with the lower margin level that you're seeing today. I was hoping you can give us an update on how you're thinking around the pace of ma margin improvement over the next few years. And in your prepared remarks, you noted the journey back to target ma margins of 3 to 5%. That's a slight change from your previous target of 4 to 5%. So, just curious, what drove that change and why 3 to 5% is the appropriate margin level? Thanks.

嗨，早安。希望以您今天看到的較低利潤水平來跟進醫療保險優勢利潤。我希望您能向我們介紹您對未來幾年利潤率改善步伐的最新看法。在您準備好的演講中，您提到了利潤率目標回到 3% 到 5% 的過程。這與您之前 4% 到 5% 的目標相比略有變化。那麼，只是好奇，是什麼推動了這項改變？謝謝。

Let me, let me answer that second part first. Because the answer to that question is really primarily mathematical, right? So as you think about the IRA changes to the part D program, significant dollars that were previously recorded as reinsurance are now going to get recorded as premium, which increases the denominator of the calculation. So, at constant dollars of margin, that change alone is significant to drive a 4% margin down into the threes. As, as you think about the longer term, It's, it's a challenging question to answer. We understand, you know, and we made deliberate changes to benefits to be able to drive improvement in margin next year. We anticipate that we'll be able to continue to do that into 2026 and our star scores will help there, right? We had great stars performance two thirds of our members will be in 4.5 star plans that will provide a little bit of additional tailwind as well. But we really need to understand what the rate environment looks like to be able to answer that question. But our goal would be to increase margins again in 2026 in that business.

讓我先回答第二部分。因為這個問題的答案其實主要是數學上的，對吧？因此，當您考慮 IRA 對 D 部分計劃的變更時，先前記錄為再保險的大量資金現在將記錄為保費，這增加了計算的分母。因此，在保證金不變的情況下，僅此變更就足以將 4% 的利潤率降至 3%。從長遠來看，這是一個很難回答的問題。我們理解，你知道，我們對福利進行了有意的改變，以便能夠推動明年利潤率的提高。我們預計我們將能夠繼續這樣做到 2026 年，我們的星級分數將對此有所幫助，對嗎？我們擁有出色的星級表現，三分之二的會員將加入 4.5 星級計劃，這也將提供一點額外的推動力。但我們確實需要了解利率環境如何才能回答這個問題。但我們的目標是在 2026 年再次提高該業務的利潤率。

Yeah. And just as it relates to the focus, obviously, my near term focus is is driving and accelerating the performance of that business. So as Tom mentioned, the stars tailwind will be very positive But for both 25 and into 26 there will be a very strong focus on total cost of care. So as we know what the pricing and the benefits are for the for the risk that we're managing to make sure we have the underlying clinical resources until the cost of care models to to manage the the risk appropriately. And then lastly, you'll see an acceleration of how we integrate the assets within this business to help us drive down the cost and improve the overall experience for the members that we're serving. So again, just reinforcing the fact that this is a really important product for our, for our business and one that we're going to have the collective enterprise focused on on execution.

是的。正如它與重點相關一樣，顯然，我近期的重點是推動和加速該業務的績效。正如湯姆所提到的，明星順風將非常積極，但對於 25 歲和 26 歲的人來說，人們將非常關注總護理成本。因此，當我們知道我們正在管理的風險的定價和收益是多少時，我們將確保我們擁有基礎的臨床資源，直到護理成本模型能夠適當地管理風險。最後，您將看到我們如何加速整合該業務中的資產，以幫助我們降低成本並改善我們所服務的會員的整體體驗。再次強調這樣一個事實，即這對我們、我們的業務來說是一款非常重要的產品，而且我們將讓集體企業專注於執行。

Thank you. We now have John Ranson with RJ Lo and Open.

謝謝。現在我們有約翰·蘭森 (John Ranson) 和 RJ Lo 以及 Open。

Hey, good morning. Signify and Oak, are they tracking in line with your expectations. Do you think that will, that trend will change in any way next year?

嘿，早安。 Signify 和 Oak，他們的追蹤符合您的期望嗎？您認為明年這種趨勢會發生什麼變化嗎？

Signifies that a great year. You know, as we noted, the volume was up, I think 37% year over year inside the third quarter. That business has continued to perform very well. Oak Street overall has performed in line with the guidance that we gave at the earlier part of the year. You know, there, they're a Medicare, you know, focused business and so they're not immune to some of the pressures that others have seen in that marketplace because of the nature of that membership. But we've been very pleased with how they performed. They've, you know, maintained a risk adjustment, headwind that's plus or minus a little bit below 3% which we feel is a great first step given the 1st year of the implementation of, of the 28. And we think that there could be some nice tailwinds in that business next year as we think about, you know, some of the changes that competitors and ourselves have made as we continue to grow our share of Aetna members inside the, those those clinics.

預示著這是偉大的一年。你知道，正如我們所指出的，第三季的銷量年增了 37%。該業務繼續表現良好。橡樹街的整體表現符合我們今年早些時候給出的指導。你知道，他們是一家專注於醫療保險的企業，因此，由於會員資格的性質，他們也無法免受其他人在該市場中看到的一些壓力。但我們對他們的表現非常滿意。你知道，他們保持了風險調整，逆風正負略低於 3%，我們認為考慮到 28 條實施的第一年，這是一個很好的第一步。車，因為我們會想到，隨著我們繼續增加這些診所內的Aetna 會員份額，我們的競爭對手和我們自己已經做出了一些改變。

And just to reinforce the importance of both of those acquisitions, Oak Street obviously is, is managing the cost far better than than the rest of our book. So the fact is the model works and it works in an underserved market specifically for a population that's important to to this business and the integration between Aetna and Oak Street are improving. So we've had a four X increase in the members since the acquisition. So I get proving out the fact that when we put the collective efforts of the business, we can't actually see performance, same thing on signify. We've seen a two X increase in the members served within Aetna. The goal here is obviously to use signify as a platform, the sophistication and the technology that they've invested around the logistics and and reaching members in their homes. It is a platform which we can certainly build beyond just the the in home assessment. So that will be the message and the focus of the business to continue to serve people both in the, in the care delivery setting as well as in the home. And we believe we have the appropriate asset to be able to execute that.

為了強調這兩項收購的重要性，橡樹街顯然在管理成本方面比我們書中的其他部分好得多。所以事實是，這個模式是有效的，而且它適用於一個服務不足的市場，特別是對這個業務很重要的人群，而安泰保險和橡樹街之間的整合正在改善。自收購以來，我們的成員數量增加了四倍。所以我證明了這樣一個事實：當我們把業務的集體努力放在心上時，我們實際上看不到績效，同樣的事情也發生在signify上。我們發現 Aetna 內部服務的會員數量增加了兩倍。這裡的目標顯然是使用signify作為一個平台，他們在物流和到達會員家中所投資的複雜性和技術。這是一個我們當然可以建立的平台，而不僅僅是家庭評估。因此，這將是該公司的資訊和重點，繼續為護理服務環境和家庭中的人們提供服務。我們相信我們擁有適當的資產來執行這項任務。

Thank you.

謝謝。

Our final question comes from Brian DKW with Jeffries. Please go ahead.

我們的最後一個問題來自 Brian DKW 和 Jeffries。請繼續。

Hey, good morning and thanks for the update on the Cost advantage program. So just curious what those discussions have been like and how do the do the contract shake out in terms of what you expected pricing structures to look like versus what the that 50% of the book looks like? And you know, how, how do you think about the opportunity or the ability to increase that number before we get to January 1st. Thanks.

嘿，早上好，感謝您更新成本優勢計劃。所以只是好奇這些討論是什麼樣的，以及合約如何根據您預期的定價結構與書中 50% 的內容進行比較？你知道，在 1 月 1 日之前，你如何看待增加這個數字的機會或能力。謝謝。

Yeah. So, so, first and foremost, as you recall, last year, we, we launched cost manage with the very intentional reason to solve one of the biggest industry challenges we had around reimbursement pressure. And so we made really good progress as David and Tom alluded to in the prepared remarks, we have over 50% of our clients in the program. We expect to have our commercial book, 100% of our commercial book signed, you know, by, by the end of this year, I'm really excited about what it brings to the marketplace and how we and some of the cross subsidization that exist in pharmacy as it relates to this. So, you know, we continue to make really good progress as it relates to the financial outlook from cost management will come back to you early next year with what we're seeing. But we continue to see really strong performance. As I mentioned earlier in our retail pharmacy business, we're really excited about what cost manage will bring to the marketplace and how it's going to transform the way we price pharmaceuticals in this country and and lastly the benefits that it brings to consumers as well. So more to come. But at this point, I would say we, we continue to make really great progress here across the board of mo moving the industry.

是的。因此，首先，正如您所記得的那樣，去年，我們出於非常有意的原因啟動了成本管理，以解決我們在報銷壓力方面面臨的最大行業挑戰之一。因此，正如 David 和 Tom 在準備好的演講中提到的那樣，我們取得了非常好的進展，我們有超過 50% 的客戶參與了該計劃。我們期望我們的商業書籍，我們的商業書籍 100% 簽署，你知道，到今年年底，我對它給市場帶來的東西以及我們如何和一些交叉補貼感到非常興奮存在於藥學中，因為它與此相關。所以，你知道，我們繼續取得非常好的進展，因為這與成本管理的財務前景有關，我們將在明年初向你回饋我們所看到的情況。但我們繼續看到非常強勁的表現。正如我之前在我們的零售藥品業務中提到的，我們對成本管理將為市場帶來什麼以及它將如何改變我們在這個國家的藥品定價方式以及最後它給消費者帶來的好處感到非常興奮。未來還會有更多。但在這一點上，我想說，我們繼續在整個行動產業中取得巨大進展。

So I I just follow on to Prince's comment about cost advantage. And we if you look at the complexity of pharmaceutical pricing in this country, this is obviously one of the paths in which to to address the confusion, the complexity of how drugs actually are priced at the consumer level. So prems move and the in the retail setting combined with the true cost drive within the, within the PB M we believe is a, is a concerted effort to address what we know is a is a headline around the confusion, the complexity of the pricing. So this elimination across subsidation, the ability to get to a more stable and and less variable pricing strategy will help us, you know, solve what we, what we know is a is a headline risk and more importantly, allow us to serve our members and our clients more effectively.

所以我只是繼續聽普林斯關​​於成本優勢的評論。如果你看看這個國家藥品定價的複雜性，這顯然是解決消費者層面藥品實際定價方式的混亂和複雜性的途徑之一。因此，Prems 的舉措和零售環境中的真正成本驅動相結合，在 PB M 中，我們認為，這是一項共同努力，旨在解決我們所知道的圍繞定價的混亂和複雜性的頭條新聞。因此，消除補貼，獲得更穩定、更少變化的定價策略的能力將幫助我們解決我們所知道的主要風險，更重要的是，使我們能夠為我們的會員提供服務和我們的客戶更有效。

So with that, we this ends the ends the call and I before closing here, I just want to thank for you for all joining the call today. I'm incredibly excited and humbled by the opportunity and the potential of this combined enterprise. We have clear line of sight into the issues and the plan is in place to address them and we look forward to providing updates on our progress going forward. And I also just want to thank again the 300,000 colleagues that help us serve our customers and our patients day in and day out. So, thank you for that support.

因此，我們的通話就到此結束，在結束前，我只想感謝大家今天加入通話。我對這家合併後的企業所提供的機會和潛力感到無比興奮和謙卑。我們對這些問題有清晰的認識，並已製定解決這些問題的計劃，我們期待提供有關我們未來進展的最新資訊。我還想再次感謝 30 萬名同事日復一日地幫助我們為客戶和患者提供服務。所以，感謝您的支持。

Thank you all for joining today's conference call with TV S Health. I can confirm today's call has now concluded. Please enjoy the rest of your day and you may now disconnect from the call.

感謝大家參加今天的 TV S Health 電話會議。我可以確認今天的通話現已結束。請享受您今天剩下的時間，您現在可以掛斷電話了。